Advertisement

Journal of Neuro-Oncology

, Volume 6, Issue 3, pp 245–250 | Cite as

Brain stem gliomas: a clinicopathological analysis of 23 histologically proven cases

  • Shunji Nishio
  • Masashi Fukui
  • Jun Tateishi
Article

Abstract

The clinical and anatomic pathological findings in 23 patients with histologically proven brain stem glioma were reviewed. Eleven patients had malignant tumors (astrocytoma, grade III, and glioblastoma multiforme) and the remaining had low grade ones. The primary site of the tumor was the pons in 15 of 21 patients examined, followed by the medulla oblongata and midbrain. Contiguous cephalad and caudad involvement of pontine tumors was evident in 14 patients, and was more extensive in the high grade gliomas. At autopsy, the tumor spread via the CSF was observed in all patients with high grade but not low grade tumors.

Open surgical posterior fossa exploration was performed on 12 patients. Volume reduction, by partial removal of the tumor and/or by cyst evacuation, was performed on seven, with good results. Nineteen patients were given radiation therapy, with temporary improvement of the clinical conditions. While none of the patients with malignant tumors survived more than 15 months after diagnosis, those with low grade tumors had a five-year actuarial survival rate of 50.0%, and three survived more than ten years after the diagnosis. Our data indicate that brain stem gliomas are not a homogeneous group of tumors as far as the clinical and pathological features are concerned. This heterogeneity shows the need to design specific treatments for these tumors.

Key words:

brain stem glioma histopathology CSF dissemination surgery radiation chemotherapy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Freeman CR, Suissa S: Brain stem tumors in children: Results of a survey of 62 patients treated with radiotherapy. Int J Radiat Oncol Biol Phys 12:1823–1828, 1986Google Scholar
  2. 2.
    Reigel DH, Scarff TB, Woodford JE: Biopsy of pediatric brain stem tumors. Child's Brain 5:329–340, 1979Google Scholar
  3. 3.
    Albright AL, Guthkelch AN, Packer RJ, Price RA, Rourke LB: Prognostic factors in pediatric brain-stem gliomas. J Neurosurg 65:751–755, 1986Google Scholar
  4. 4.
    Berger MS, Edwards MSB, LaMasters D, Davis RL, Wilson CB: Pediatric brain stem tumors: Radiographic, pathological, and clinical correlations. Neurosurgery 12:298–302, 1983Google Scholar
  5. 5.
    Epstein F: A staging system for brain stem gliomas. Cancer 56:1804–1806, 1985Google Scholar
  6. 6.
    Epstein F, McCleary EL: Intrinsic brain-stem tumors of childhood: surgical indications. J Neurosurg 64:11–15, 1986Google Scholar
  7. 7.
    Littman P, Jarrett P, Bilaniuk IT, Rorke LB, Zimmerman RA, Bruce DA, Carabell SC, Schut L: Pediatric brain stem gliomas. Cancer 45:2787–2792, 1980Google Scholar
  8. 8.
    Stroink AR, Hoffman HJ, Hendrick EB, Humphreys RP: Diagnosis and management of pediatric brain-stem gliomas. J Neurosurg 65:745–750, 1986Google Scholar
  9. 9.
    O'Brien MS, Johnson MM: Brain stem gliomas. In: Wilkins RH, Rengachary SS (ds) NEUROSURGERY. McGraw Hill, New York, 1985, pp 762–766Google Scholar
  10. 10.
    Hueftle MG, Han JS, Kaufman B, Benson JE: MR imaging of brain stem gliomas. J Comput Assist Tomogr 9:263–267, 1985Google Scholar
  11. 11.
    Hood TW Gebarski SS, McKeever PE, Venes JL: Stereotaxic biopsy of intrinsic lesions of the brain stem. J Neurosurg 65:172–176, 1986Google Scholar
  12. 12.
    Albright AL, Price RA, Guthkelch AN: Brain stem gliomas of children. A clinicopathologic study. Cancer 52:2313–2319, 1983Google Scholar
  13. 13.
    Coffey RJ, Lunsford LS: Stereotactic surgery for mass lesions of the midbrain and pons. Neurosurgery 17:12–18, 1985Google Scholar
  14. 14.
    Lassiter KRL, Alexander E Jr, Davis CH Jr, Kelly DL Jr: Surgical treatment of brain stem gliomas. J Neurosurg 34:719–725, 1971Google Scholar
  15. 15.
    Tomita T, McLone DG, Naidich TP: Brain stem gliomas in childhood: Rational approach and treatment. J Neuro-Oncol 2:117–122, 1984Google Scholar
  16. 16.
    Hoffman HJ, Becker L, Craven MA: A clinically and pathologically distinct group of benign brain stem gliomas. Neurosurgery 7:243–248, 1980Google Scholar
  17. 17.
    Villani R, Gaini SM, Tomei G: Follow-up study of brain stem tumors in children. Child's Brain 1:126–135, 1975Google Scholar
  18. 18.
    Golden GS, Ghatak NR, Hirano A, French J: Malignant glioma of the brain-stem. A clinicopathological analysis of 13 cases. J Neurol Neurosurg Psychiatry 35:732–738, 1972Google Scholar
  19. 19.
    Mantravadi RVP, Phatak R, Bellur S, Liebner EJ, Haas R: Brain stem gliomas: An autopsy study of 25 cases. Cancer 49:1294–1296, 1982Google Scholar
  20. 20.
    Albright AL, Sclabassi RJ: Use of the Cavitron ultrasonic surgical aspirator and evoked potentials for the treatment of thalamic and brain stem tumors in children. Neurosurgery 17:564–568, 1985Google Scholar
  21. 21.
    Heppner F, Oberbauer RW, Ascher PW: Direct surgical attack on pontine and rhombencephalic lesions. Acta Neurochir, Suppl 35:123–125, 1985Google Scholar
  22. 22.
    Soffer D, Sahar A: Cystic glioma of the brain stem with prolonged survival. Neurosurgery 10:499–502, 1982Google Scholar
  23. 23.
    Epstein F, Murali R: Pediatric posterior fossa tumors: Hazards of the ‘preoperative’ shunt. Neurosurgery 3:348–350, 1978Google Scholar
  24. 24.
    Salazar OM, Rubin P, McDonald JV, Feldstein ML: High-dose radiation therapy in treatment of glioblastoma multiforme: A preliminary report. Int J Radiat Oncol Biol Phys 1:717–727, 1976Google Scholar
  25. 25.
    Salazar OM, Rubin P: The spread of glioblastoma multiforme as a determining factor in the radiation treated volume. Int J Rad Oncol Biol Phys 1:627–637, 1976Google Scholar
  26. 26.
    Greenberger JS, Cassady JR, Levene MB: Radiation therapy of thalamic, midbrain and brain stem gliomas. Radiology 122:463–468, 1977Google Scholar
  27. 27.
    Nishio S, Korosue K, Tateishi J, Fukui M, Kitamura K: Ventricular and subarachnoid seeding of intracranial tumors of neuroectodermal origin — A study of 26 consecutive autopsy cases with references to focal ependymal defect. Clin Neuropathol 1:83–91, 1982Google Scholar
  28. 28.
    Nishio S, Fukui M, Ohta M, Tateishi J, Kitamura K: Spinal subarachnoid seeding from glioblastoma multiforme of the brain stem. Report of three autopsy cases. Neurol Med Chir (Tokyo) 23:566–570, 1983Google Scholar
  29. 29.
    Fulton DS, Levin VA, Wara WM, Edwards MS, Wilson CB: Chemotherapy of pediatric brain-stem tumors. J Neurosurg 54:721–725, 1981Google Scholar
  30. 30.
    Jenkin RDT, Boesel C, Ertel I, Evans A, Hittle R, Ortega J, Sposto R, Wara W, Wilson C, Anderson J, Leikin S, Hammond D: Brain-stem tumors in childhood: a prospective randomized trial of irradiation with and without adjuvant CCNU, VCR, and prednisone. A report of the childrens cancer study group. J Neurosurg 66:227–233, 1987Google Scholar
  31. 31.
    Levin VA, Edwards MS, Wara WM, Allen J, Ortega J, Vestnys P: 5-Fluorouracil and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) followed by hydroxyurea, misonidazole, and irradiation for brain stem gliomas: A pilot study of the brain tumour research centre and the children's cancer study group. Neurosurgery 14:679–681, 1984Google Scholar

Copyright information

© Kluwer Academic Publishers 1988

Authors and Affiliations

  • Shunji Nishio
    • 1
  • Masashi Fukui
    • 1
  • Jun Tateishi
    • 2
  1. 1.Department of Neurosurgery, Neurological Institute, Faculty of MedicineKyushu University 60FukuokaJapan
  2. 2.Department of Neuropathology, Neurological Institute, Faculty of MedicineKyushu University 60FukuokaJapan

Personalised recommendations